AGING AND PHYSICAL FUNCTION - IT'S A BALANCING ACT.

Fact #1. Falls are the number one cause of injury in those aged 65 years and over.

Fact #2. In 2016, almost 10% of hospital admissions for over 85’s in New Zealand were the result of a fall.

Fact #3. The average hospital stay following a fall in those over 85 was just shy of 2 weeks (Health Quality & Safety Commission NZ).

Balance is one of those crucial things that unfortunately starts to deteriorate in our later years. When it does, the consequences can be hugely debilitating. A significant fracture, such as a broken hip, is often the start of a downward spiral in health due to the loss of strength and independence that occurs during recovery. So much so that a meta-analysis completed in 2005 (an analysis of the results of multiple studies) demonstrated a 5-fold and almost 8-fold increase in the likelihood of death within 3 months of a hip fracture, for women and men respectively!

But why does balance get worse as we age? And what can we do to prevent it?

There are three systems in the body that work together for maintaining balance - Vision, the vestibular system, and the proprioceptive system (what the heck are those?!)

The importance of vision for balance is a no-brainer. We receive sensory information through our eyes about the world around us - changes in the environment as we navigate through space, movements of objects around us, and potential hazards in our path. Our eyes also provide feedback for whether our world is still upright, or if the floor is getting closer to us! If you ever doubt the role that your vision has for balance then try standing on one foot with your eyes open, and then eyes closed. Not so easy huh? (*disclaimer* - try this at your own risk!).

The second system is our vestibular system. The vestibular system resides within the inner part of the ear, and is made up of the semicircular canals (which detect rotation/ angular acceleration), and the otoliths (which detect linear acceleration). The canals contain a fluid which moves within the three dimensional structure when the orientation of the head changes. The movement of this fluid against tiny hair cells within the canals signals the change in orientation of the head in all planes of movement, and this message is passed on to the brain.

The third system is our proprioceptive system. The proprioceptive system receives sensory feedback from the skin, tendons and muscles to indicate the position of your body in space. We have special receptors within these tissues (muscle spindles and golgi tendon organs) which can detect changes in length, stretch and tension in the tissue, allowing the brain to determine the position of the joint. Proprioception is the reason that you are able to do things like touch your nose with your eyes closed! There are also pressure sensors on our feet that can detect any changes in weight distribution between the two feet.

The information received from each of these three systems is interpreted collectively to allow the brain to make decisions regarding balance and stability. And all this happens without you even thinking about it! Pretty cool. But if any of these systems are impaired, it can have significant implications for our balance.

When we age, the efficiency of the brain to process and interpret these signals slows. It takes longer for the messages to be passed from the sensory receptors to the brain, and the quality of the signal may be reduced (i.e. deterioration in vision, or dysfunction in the vestibular system). Not only this, but the response to any change in balance is also slowed - it takes longer for the instructions being sent from the brain to reach the right muscles. Hence, we see a lack of coordination, slowed reflexes, and slowed response rate to anything that threatens balance.

Couple all of this with…

a. The loss of muscular strength and power (as we age, our muscles fibers also change, becoming slower to respond and less able to generate power), and,

b. Joint stiffness / reduced flexibility (making it difficult for our joints to move through their full range of motion),

…And we have the perfect recipe for a date with the orthopaedic surgeon!

The good news is that there are simple exercises that we can do to improve balance and prevent a fall.  Balance training can be done at home and requires very little equipment or space - just 10 minutes of training a day is enough to elicit an improvement! As with most things in the body, if we don’t use it, we lose it - so there is no better time than now to get started.

Here are a few tips:

- A simple way to challenge balance is to reduce the size of the base of support (the contact area of our feet on the ground). A few examples include standing with feet close together, standing in tandem stance (heel to toe with one foot in front of the other), or standing on one foot.

 - We can also challenge balance by reducing the amount of sensory feedback being sent to the brain. A few ways to do this are by reducing our visual feedback (closing one or both eyes - do this one next to a wall if you feel unsteady!), or changing the surface of the ground - standing on top of something bumpy, soft or squishy like a pillow or rolled up towel.

 - Flexibility of the lower body (particularly the ankles) is important for balance as it allows the joints to move through their full range of motion. Ankle circles and calf stretches are a good start. Make the ankle circles as big as you can, clockwise and anticlockwise, then try pushing the toes away from you, and pulling them back towards you to stretch the front and back of the ankles.

 - Try to take your shoes off when doing balance exercises at home - this makes it slightly more challenging by reducing the support offered by your shoes. It also allows the receptors on the bottom of your feet to become more sensitive to the sensory information being received from the ground, improving the ability for the body to respond quickly to a loss of balance when needed.

KinetEx offers group exercise classes specifically catered for fall prevention in the elderly. These classes include balance, flexibility, and strength training to both prevent a fall from happening, and reduce the significance of the consequences if one does occur.

Are you interested in joining one of our group balance classes? Send us a quick message telling us a bit about yourself and we will be in contact soon!